Complications of Sinus Surgery
Joseph Han, MD
Jay M. Dutton, MD, FACS
Surgery of the nasal cavity or its adjacent paranasal sinuses is usually recommended only after medical management has failed and further intervention is required. Even though surgical intervention is relatively common and usually effective in improving refractory symptoms, these types of procedures are not without risk. Patients must be aware of these risks before electing to proceed and weigh the benefits of the procedure against the risks involved. A discussion regarding the risks, benefits and possible alternatives to surgery between the patient and surgeon is strongly encouraged
The list of risks described in this article is not intended to be all-inclusive, but rather to highlight some of the more common or important risks relative to nasal and sinus surgery.
Complications of nasal (septum and turbinate) surgery
COMPLICATIONS OF SINUS SURGERY
- Bleeding: It is normal to have some degree of bleeding after surgery on the nasal septum (the wall that divides the two sides of the nasal cavity) or turbinates (intranasal structures that filter and humidify air). Rarely does this require additional intervention and extremely rarely does it require blood transfusion. Non-steroidal anti-inflammatory agents (NSAIDS, such as aspirin or ibuprofen) and certain over-the-counter (OTC) supplements such as vitamin E and gingko can increase the risk of bleeding, so patients should consult with their physicians regarding the use of any medications before or after surgery. Postoperative bleeding most commonly occurs within the first 24 hours of the procedure, but can be delayed days or even weeks. If the bleeding causes a hematoma (blood clot) within the septum, removal of the hematoma is necessary, and the development of scar tissue or even nasal collapse could occur.
- Intracranial complications: The floor of the brain is where the septum attaches to the roof of the nose. If this thin bony layer is fractured, brain fluid (cerebrospinal fluid or CSF) can leak into the nose. While rare, this is likely to be identified and repaired in the operating room at the time of the primary surgery. In rare cases, this could lead to infection of the lining of the brain (“meningitis”), bleeding into the brain or the need for further intracranial surgeries.
- Impaired sense of taste or smell: The sense of smell usually improves after the procedure because airflow is restored, although in sporadic cases it could worsen depending on the extent of swelling, infection, or allergy. This impairment is often temporary but can be prolonged.
- Nasal obstruction: Much of the nasal septum is made of cartilage, which has "memory" - the propensity to move back to its original position. Although preventative measures are performed by the surgeon at the time of procedure, the cartilage may move after the surgery which may rarely lead to persistent blockage. Surgery typically improves airflow, but in some patients it may not improve or rarely may worsen. Small scar bands may also occur in the nose and require removal by the surgeon at postoperative visits.
- Numbness: Numbness of the front upper teeth, lip or nose may occur after surgery but is usually self-limiting and does not require further treatment.
- Change in appearance: The septum contributes to a significant portion of the bridge of the nose and the base of the nose near the upper lip. Although surgery on the septum alone typically doesn’t change the appearance of the external nose, such changes are possible.
- Pain, dryness: The turbinates are “swell bodies” that are present along the sidewall of the nasal cavity. They often become too enlarged and their size is physically reduced during nasal surgeries, and this often improves symptoms such as nasal congestion of obstruction. However, in some patients this may leave them with the sensation of being overly dry or even cause chronic pain; a very rare but severe form of this is referred to as “empty nose syndrome.”
- Intraorbital complications (damage to the eye or surrounding tissue): The eye is situated directly next to several of the paranasal sinuses and is separated from them by a thin layer of bone. Because of the close proximity, in rare cases, bleeding may occur into the orbit, requiring treatment at the time of the initial surgery. Visual loss and blindness have been reported but are extremely rare. Another uncommon problem is damage to the muscles that move the eye, leading to double vision, which can be temporary or permanent. In certain circumstances, there may be a change in the function of the tear ducts causing excessive tearing. Since the eye is in close proximity to the sinuses, a major orbital complication or blindness could possibly occur even without surgery for patients with severe or refractory sinus infections.
- Intracranial Complications: (see above)
- Bleeding: (see above)
- Voice changes: One of the functions of the sinuses is to affect resonance, so vocal professionals should be aware of potential changes in their voice after sinus surgery.
- Impairment of smell or taste: (see above)
- Infection: The most common reason to undergo sinus surgery is a chronic sinus infection that does not resolve with medications. The patient with sinusitis is therefore at risk of developing certain other infections in this area (abscesses, meningitis, etc.) from sinus surgery, although it important to recognize that this is also a complication of not undergoing surgery for a refractory chronic sinus infection.
- Nasal obstruction, dryness and pain: (see above)
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